Inside the Injury Report (Jonathan Stewart)
By Jene Bramel
August 24th, 2010

Jonathan Stewart barely practiced last season with a painful Achilles tendon condition and still managed a frighteningly good 5.1 YPC and ten touchdowns. Nearly 102 of his 221 carries in 2009 came during the last five games of the season. Despite the impressive production, after surgery shortly after the regular season ended, there's reason to be concerned about Stewart's prospects, both in 2010 and the long term.

What's the injury?

Multiple sources have reported that the cause of Stewart's heel pain was due to a number of factors. Achilles' tendonitis is not uncommon in athletes, but Stewart's original symptoms were presumably a compensatory injury after a slight change in his running style while working through his past toe injuries put more stress on his opposite heel. Stewart and the team's training staff elected to treat the tendonitis conservatively with rest and other non-surgical treatments and he was able to put the pads on and play through the pain.

Not surprisingly, Stewart continued to have pain after playing and developed bone spurs and bursitis in and around where the Achilles' tendon inserts onto the heel bone. Stewart's surgery in January shaved down those bone spurs, removed the calcium deposits within the tendon and removed some of the bursa sacs (small, fluid-filled cushions) around the insertion site.

What's the medical prognosis?

Since we'll never get a full account of the severity of Stewart's condition, we can only speculate on how Stewart may recover. I've not been able to find any indication that Stewart's tendon showed any significant tearing or that he had the tendon reinforced with muscle or tendon fibers from other sites. It's controversial whether athletes with chronic Achilles' tendon inflammation, thickening and bone spur formation are more likely to have a later rupture, but the lack of a report of surgical repair of the tendon itself is reassuring in Stewart's case.

Interestingly, though the studies aren't definitive, surgery tends to be more effective in athletes than non-athletes. Given Stewart's access to the best specialists and training staffs available, that tendency bodes well for Stewart's recovery. Chronic soreness, limitations in range of motion and recurrent bone spurs and bursitis remain important risks for Stewart's future.

What's the fantasy prognosis?

Stewart was cleared for contact before the second preseason game. He was quoted as saying that he still felt pain in the area, but was happy to be making gradual steps toward doing team drills and getting into game action before the regular season opens. Dealing with soreness in this area and taking few practice reps to prepare for game contact isn't anything new for Stewart. But if Stewart isn't able to return to a full practice schedule before opening weekend, it's reasonable to expect him to start slowly until he gets his game legs back and regains confidence in the areas of soreness. Stewart himself expressed a similar sentiment, saying that he needs to "go out there and get some contact, get my pad level down, just things that a football player needs to do and feel before he plays a competitive season."

In the short term, look for the Panthers to ease Stewart back to his 2009 workload. He may not see more than 10-12 carries during the first month of the season. If Stewart is healthy enough to practice during the week this year, it will obviously be a strong indication that he's ready to assume a bigger workload. That's a scary thought for opposing defenses who weren't able to stop a never fully healthy Stewart during his first two years in the league. Early reports are promising enough that Stewart looks like a good risk in the RB18-24 range as a high upside RB2. If Stewart begins practicing without setbacks before your draft, he becomes an acceptable risk as soon as the early 4th round.

Long term, it shouldn't be too alarming if Stewart continues to experience some soreness. But any mention of recurrent bone spurs or another surgery to remove additional important bursa structures or reinforce the tendon and Stewart becomes a much riskier bet to have the long, productive career many see in his future.

Questions, suggestions and comments are always welcome to bramel@footballguys.com.

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